Aetiology and Clinical Presentation of Obstructive Jaundice at PIMS, Islamabad

Objective: To determine the aetiological spectrum and clinical presentation of the obstructive jaundice in the local set up.Study Design: Descriptive study.
Place and Duration of Study: Department of Surgery, Pakistan Institute of Medical Sciences, Islamabad, from January 2004 to December 2008.
Patients and Methods: All patients of either gender above 14 years of age, having clinical picture of obstructive jaundice were included. Patients with typical clinical features, and haematological and ultrasonographical findings suggestive of obstructive jaundice were evaluated in detail. Data were collected on proformas and spectrum of aetiology and clinical presentation of obstructive jaundice was studied.
Results: 179 patients were collected with mean age of 52.5 years. Female to male ratio was almost equal (11:10). The most common aetiologies of obstructive jaundice were malignancy followed by gallstones in both genders. The common symptoms were abdominal pain and darkening of urine; while jaundice and right upper quadrant tenderness were the common signs.Conclusions: Malignancy was the commonest cause of obstructive jaundice, while gallstones were the commonest benign cause. The determination of preoperative clinical indices is needed for actual outcome of obstructive jaundice.
Keywords: Jaundice, Obstructive Jaundice, Aetiology, Gallstones, Carcinoma head of Pancreas, Darkening of urine

Introduction

Jaundice is a yellowish staining of the skin, sclera and mucous membranes by deposition of bilirubin in these tissues.¹ Causes of jaundice can be classified into pre-hepatic, hepatic or post hepatic. The term “obstructive jaundice” implies partial or complete obstruction to the flow of bile and its components into the intestinal tract.^{2, 3} Obstructive jaundice is not a disease, it is just a symptom of many other diseases. Therefore, early and prompt evaluation to establish the underlying cause is crucial to avoid secondary pathological changes that may develop if obstruction is not relieved.⁴ The aim of investigations in obstructive jaundice is to know level and cause of obstruction,⁵ as the identification of cause of biliary obstruction is very important before planning any

Patients and Methods 

From January 2004 to December 2008, 179 adult patients with a diagnosis of obstructive jaundice were admitted at the surgical unit III, Department of General Surgery, Pakistan Institute of Medical Sciences, Islamabad. All of them had biochemical and ultrasound features suggesting dilatation of intrahepatic or extrahepatic biliary channel. Routine laboratory work up included blood complete picture, urine analysis, blood sugar, serum electrolytes, liver function tests (LFTs), renal function tests, coagulation profile, and viral serology; chest x-ray and ultrasound were also performed as a routine. CT scan, ERCP, PTC and MRCP were performed in selected cases where indicated. Data were recorded on a specific proforma and processed by using SPSS version 11. Results were reported as percentages for categorical variables.
For Complete Abstract on your email Pls. Contact Chief Editor APIMS